First Name *

Last Name *

Phone *

Email *

Age, Height, Current Weight *

How many meals/day do you eat? *

How many calories do you shoot for daily? *

Don't know? Put N/A

How much protein do you have daily? *

If you don't know grams, do you have a serving with each meal? Still don't know? Put N/A

And what kind of proteins do you eat? *

Lean chicken, steak, fish, shakes, legumes, etc.

What are you snacking on between meals? Be specific *

Chips, Cheezits, Jerky, Fruit, Protein Bars, Cakes, Cookies, etc.

How many times/week do you eat out or order takeout? And where? *

What restaruants are you going to and how often?

How much water do you drink daily? *

Roughly how many 16.9 oz bottles?

What’s your daily step count at? *

Don't know, put N/A

What’s your goal? Click all that apply

On a scale of 1-10 how would you rate the following on how you feel daily?

Hunger (10= always hungry, 1= never hungry)
Energy (10=high energy, 1= no energy)
Cravings (10=high cavings, 1= none)
Mood (10=normal mood, 1=mood swings daily)
Sleep (10= sleep amazing, 1= terrible sleep)

Any additional information you want to provide me?

Like past diets, current diet, medications you are on etc....